new question on wet to dry dressing changes

kgh31386, BSN, MSN, RN · Jan 6, 2009

Idea....technically you don't have to have your sterile gloves on to open the kit or take the drape out. Because if you make sure you don't touch anything else in the kit, you can pinch the drape on the blue side(or shiny side depending on the drape) and touch that 1 inch around the edge perimeter to let it open and lay it down blue side down making sure you lay it down coming towards you(this avoids laying it down away from you and reaching over it). Then you can touch the bottom of the kit package and carefully dump the stuff onto the drape. Then you can pour your saline into the empty compartment...then put on your sterile gloves? Maybe that'll work? Or just contaminate one hand and keep one hand sterile...

Daytonite, BSN, RN · Jan 7, 2009

I was always taught to bring an extra set of sterile gloves with me in case this happens. You set up your sterile field. Take off your sterile gloves and discard them. Pour your sterile saline into the sterile container. Then, open the extra pair of sterile gloves that you brought with you and put them on. You are now ready to do your sterile dressing change.

kgh31386, BSN, MSN, RN · Jan 7, 2009

that sounds easy enough. but suppose you do happen to forget that extra set of gloves?

Daytonite, BSN, RN · Jan 7, 2009

that sounds easy enough. but suppose you do happen to forget that extra set of gloves?

Turn on the call light and have someone bring you a pair.

netglow, ASN, RN · Jan 11, 2009

We were taught to be able to deal with whatever the clinical site had... some have everything you would want, others kinda stingy. Mostly, I've had to work with a not so good kit, having to add to it. So, you just have to be mindful of when you are sterile and when you are not... Don't hover over your field, and you can add gauze etc to it before you put on your sterile gloves! (remember you've got your 1 inch perimeter on your drape) open those little packets w/o touching the inside, and plop those gauze pads on your field from above and in from the side. You can carefully set up quite a lot before you put on those gloves... takes a lot of practice not to violate your field... keep your hands from moving below waist level... practice, practice, look in your skills book, I know :yawn: .

cpartrid · Jan 18, 2009

Our instructor had us dump the kit's contents onto the sterile mat (just tip the kit over- you don't need to have sterile gloves on since the outside of the kit doesn't need to be sterile). After you put on your gloves you can put the gauze/saline into whatever compartment you want.

tnortham · Jan 21, 2009

I have never had that problem. At the hospitals I do clinicals at there are separate gauze and saline. There isn't a kit. (Not every one has the same size wound). So you open the gauze packet and pour the saline into the gauze packet...it becomes your compartment. It is sterile because the gauze you just opened is sterile. And it is just a good habit to bring extra sterile gloves;and supplies if you don't use them just leave them in the room for the next dressing change.

lpnflorida · Jan 21, 2009

1. Gather equipment:

Dressing kit

Saline solution

Sterile 30-60cc syringe

Extra 4x4s, Kerlex gauze

Blue bed pad

Extra tape

Sterile gloves

Non-sterile gloves

2. Check order for any additional equipment.

3. Introduce self and explain procedure.

4. Wash hands and don non-sterile gloves.

5. Provide client with privacy and prepare:

a. Acquire assistance for changing dressing on restless or confused adults.

Assist client to comfortable position in which wound can be readily exposed.

6 Expose only wound area, using bath blanket if necessary; place blue

pad under area to absorb any spillage.

7. Gently remove old dressing, discard in trash; if dressing is heavily saturated with drainage or blood (greater than 100cc ), place in a biohazard bag according to policy.

8. Remove gloves and wash hands.

9. Open sterile gloves and open dressing kit.

10. Open any extra supplies and place on sterile field.

11. Don sterile gloves and arrange items in kit.

12. If alone, pour sterile saline onto the field, and remove gloves and

re-glove. If you have an assistant, have them pour the sterile saline

onto field..

13. Soak at least three 4x4(s) with saline.

14. Draw up 30-60cc of irrigating saline or medicated solution.

15. Gently irrigate wound by squirting saline solution slowly onto open wound, starting at the top of wound to the bottom.

16. If unable to drain, lightly pack wound to absorb any excessive solution.

17. At this time, you can also check for tunneling and take wound measurements if needed.

18. Clean wound from inner aspect to outer: top to bottom avoid going over an area already cleaned. Use at least three 4x4s.

19. If drain is present, clean in a circular motion from inner to outer.

20. Clean again in the same manner with betadine solution (if ordered).

Betadine is not recommended for wound irrigation, and some

facilities have standing orders for wound care.

Please read your clinical site�s policies prior to doing wound care.

Some facilities have an Enterostomal Therapist Nurse (ET Nurse)

or Physical Therapist who coordinates wound care.

21. Soak 4x4s or kerlix, then squeeze out and fluff.

22. Place 4x4s into wound and lightly pack the wound.

23. Place split dressing around drain.

24. Cover with abdominal dressing to enclose the entire wound.

25. Remove gloves, and tape dressing securely.

Since this dressing is changed frequently use the least amount of

tape or use Montgomery Straps to keep in place.

26. Clean up area and make client comfortable and secure.

27. Document Wound Care on the chart:

Time changed

Wound appearance, margins, any sutures, stitches

Any drainage, color, amount, odor

How client tolerated procedure

Equipment used

Any medications used

( personally I use the pack that sterile 4x4 or kerlix comes in and put my sterile solution into those containers after they are opened.)